Evaluation of commonly used adjuvants in the prevention of postoperative adhesions.

The uterine horns of 30 rats were subjected to both division and microsurgical anastomosis of the proximal segment and division only of the distal segment. They were equally assigned to three groups, of which group 2 received dexamethasone and group 3 received ibuprofen preoperatively and postoperatively for a total of eight doses. During operation, five rats of each group were irrigated with normal saline and the other five, with 32% dextran 70 (Hyskon). The left uterine horn was anastomosed with 7-0 coated Vicryl, and the right horn, with 7-0 Dexon-S sutures. At repeat laparotomy 2 weeks later, the intraperitoneal adhesions were graded blindly according to their severity. Tissue blocks were obtained from the areas of anastomosis and division only for histologic assessment. Total adhesion scores were 104 for group 1, 53 for group 2 (p less than 0.05), and 90 for group 3 (p = 0.7). The histologic evaluation showed no difference between the three groups. The inflammatory tissue reaction was least around the areas of division only and greatest at the anastomotic sites, where it was most pronounced around the surgical knots. No difference in gross adhesions or histologic assessment was observed between the left horn and the right horn. Adhesions were significantly less in the Hyskon-treated animals (p less than 0.05) but the histologic evaluation showed similar inflammatory reactions. These results suggest that in this species there is no difference between Dexon-S and coated Vicryl sutures, that dexamethasone and Hyskon are effective in preventing postoperative adhesions, and that the inflammatory tissue reaction is not altered by these adjuvants but is significantly augmented by the presence and quantity of suture material.